NPIMap

Individual provider Active NPI

Gautam S Choure, M.D.

  • Nephrology Physician
  • Mesa, AZ
National Provider Identifier
1245352574
Registry record updated May 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
43064 Issued in AZ
Practice address
612 W Baseline Rd
Mesa, AZ 85210-6041
Phone
(480) 834-9039
Fax
(480) 964-7802
NPI assigned
Apr 6, 2007
Last updated
May 25, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 25, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X MT192264 PA
Nephrology Physician 207RN0300X 43064 AZ Primary
Nephrology Physician 207RN0300X A112711 CA

Addresses

Primary practice location

612 W Baseline Rd
Mesa, AZ 85210-6041

Mailing address

612 W Baseline Rd
Mesa, AZ 85210-6041
Phone (480) 834-9039

Other identifiers 1

IdentifierTypeStateIssuer
520072MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100921000946 AZ Practitioner - Nephrology 8123143609 Reassigns benefits to 1 organization
I20101019001580 TX Practitioner - Nephrology 8123143609 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Desert Kidney Associates PLCGroup PAC ID 4284611286, 27 clinicians

Practice addresses (Care Compare)

612 W Baseline Rd
Mesa, AZ 85210-6041
Phone (480) 834-9039

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A112711CAMDNephrology Physician
MT192264PAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gila River Health Care Corporation Current Accepting new patients
Gila River Health Care Corporation CurrentSince Oct 1, 2010 Accepting new patients
Arizona Spine and Joint Hospital LLC Current Accepting new patients
Gila River Health Care CurrentSince Oct 1, 2010 Accepting new patients
Clinica la Familia, PC Family Medicine PastSince Aug 1, 2003 Accepting new patients

Locations

17487 S Healthcare Dr
#H
Laveen, AZ 85339
Phone (520) 550-6000

48203 W Farrell Rd
#H
Maricopa, AZ 85139
Phone (520) 568-3881

Interoperability endpoints

  • Direct secure messaging: gautamchoure@asjh.medalliesdirect.net
  • Direct secure messaging: gchoure23231@direct.acumenmd.com
  • Direct secure messaging: gehgchour@yourcarecommunity.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337904000000",
    "number": "1245352574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 W BASELINE RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106041",
            "telephone_number": "480-834-9039",
            "fax_number": "480-964-7802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 W BASELINE RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106041",
            "telephone_number": "480-834-9039",
            "fax_number": "480-964-7802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOURE",
        "first_name": "GAUTAM",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-06",
        "last_updated": "2012-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "PA",
            "license": "MT192264",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AZ",
            "license": "43064",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A112711",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "520072",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.